GERD & Acid Reflux
GERD & Acid Reflux Care
Comprehensive evaluation and treatment of GERD, chronic heartburn, and Barrett's esophagus — guideline-based care from Dr. Azaan Ramani, DO across Dallas–Fort Worth.
Gastroesophageal reflux disease (GERD) affects roughly 1 in 5 American adults and is one of the most common reasons patients see a gastroenterologist. The goal of modern GERD care is not just symptom relief — it is preventing complications such as Barrett's esophagus, esophageal stricture, and esophageal adenocarcinoma.
What Is GERD?
GERD occurs when stomach contents reflux into the esophagus frequently enough to cause symptoms or tissue injury. The most common drivers include:
- Lower esophageal sphincter (LES) dysfunction
- Hiatal hernia
- Obesity and increased intra-abdominal pressure
- Delayed gastric emptying (including from GLP-1 medications — see the GLP-1 GI page)
- Pregnancy, smoking, alcohol, certain medications
Symptoms
- Typical: heartburn, regurgitation
- Atypical: chronic cough, hoarseness, throat clearing, asthma, dental erosion
- Alarm symptoms (warrant prompt endoscopy): dysphagia, odynophagia, weight loss, GI bleeding, iron-deficiency anemia, persistent vomiting, family history of esophageal/gastric cancer
Diagnosis
Per the 2022 American College of Gastroenterology (ACG) GERD guideline, an empiric trial of acid suppression is appropriate first-line for patients with classic symptoms and no alarm features. Endoscopy is indicated for:
- Alarm symptoms (dysphagia, weight loss, bleeding, anemia)
- Inadequate response to PPI
- Barrett's esophagus screening in high-risk patients (chronic GERD ≥5 years plus risk factors: male, age >50, white, central obesity, smoking, family history)
- Refractory or recurrent symptoms after stopping therapy
Additional studies when needed:
- Ambulatory pH or pH-impedance testing — to confirm pathologic acid exposure or non-acid reflux
- High-resolution esophageal manometry — for atypical symptoms or before anti-reflux surgery to exclude motility disorders
- Barium swallow — selectively for anatomic evaluation
Treatment
Lifestyle & weight management
- Weight loss in overweight or obese patients (highest-evidence intervention)
- Avoid eating within 3 hours of bedtime
- Head-of-bed elevation (6–8 inches)
- Avoid trigger foods personalized to the patient (citrus, tomato, chocolate, mint, fatty meals, carbonated drinks)
- Smoking cessation, moderate alcohol
Pharmacotherapy
- PPI (omeprazole, pantoprazole, esomeprazole, dexlansoprazole) — first-line; once daily 30–60 min before breakfast for 8 weeks
- H2 blockers (famotidine) — for milder symptoms or as adjunct
- Alginates (Gaviscon Advance) — for postprandial reflux
- Vonoprazan — newer potassium-competitive acid blocker, FDA-approved for erosive esophagitis
- Step-down to lowest effective dose; on-demand or intermittent therapy when feasible
Procedural and surgical options
- Transoral incisionless fundoplication (TIF)
- Magnetic sphincter augmentation (LINX)
- Laparoscopic Nissen or Toupet fundoplication
- Bariatric surgery — particularly Roux-en-Y gastric bypass, often most durable in obesity-related GERD
Barrett's esophagus surveillance and treatment
Patients diagnosed with Barrett's undergo periodic endoscopy with biopsies based on dysplasia status (no dysplasia: every 3–5 years; low-grade dysplasia: ablation or close surveillance; high-grade dysplasia or intramucosal cancer: endoscopic eradication).
GERD & Acid Reflux: Common Questions
When should I see a gastroenterologist for acid reflux?
See a gastroenterologist for: symptoms >2× per week, inadequate response to 8 weeks of PPI, alarm symptoms (dysphagia, weight loss, bleeding, anemia), or Barrett's esophagus risk factors (chronic GERD plus male sex, age >50, central obesity, smoking, or family history of esophageal cancer).
Are PPIs (Prilosec, Nexium, Protonix) safe long-term?
PPIs have a generally favorable long-term safety profile when used at the lowest effective dose. Modest population-level associations exist (kidney disease, fractures, B12, C. diff) but causation is not proven. The 2022 ACG guideline supports continued use when indicated, with periodic reassessment.
Can GERD be cured?
GERD is typically managed rather than cured. Most patients achieve excellent control with weight loss, lifestyle changes, and acid suppression. A minority require anti-reflux or bariatric surgery for durable improvement.
What is the connection between GERD and Barrett's esophagus?
Long-standing GERD can cause the esophageal lining to change to Barrett's esophagus, which raises esophageal adenocarcinoma risk. ACG recommends one-time screening endoscopy for chronic GERD plus 3+ risk factors. Surveillance intervals are based on dysplasia status.
Can GLP-1 medications make GERD worse?
Yes — GLP-1 medications slow gastric emptying which can worsen reflux. Helpful:
smaller meals, avoiding late-night eating, head-of-bed elevation, and PPI/H2 blocker therapy. See the
GLP-1 GI page.
Should I get an endoscopy for chronic heartburn?
Not always. Empiric PPI is appropriate first-line for classic GERD. Endoscopy is recommended for: alarm symptoms, inadequate PPI response, Barrett's screening in high-risk patients, or refractory/recurrent symptoms.
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